Provider Demographics
NPI:1740528546
Name:WALLIS, ELIZABETH LEANNE (APN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEANNE
Last Name:WALLIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-8606
Mailing Address - Country:US
Mailing Address - Phone:870-845-6060
Mailing Address - Fax:
Practice Address - Street 1:110 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-8606
Practice Address - Country:US
Practice Address - Phone:870-845-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily